Clinical Domains
Primary Care, Tele-Health/Tele-Medicine
Clinical Role(s)
Primary Care Provider, Registered Nurse
Patient Condition(s)
Skin lesion
Scenario Type
Brief
Strength of Evidence
Date Last Reviewed
04/18/2018
Source
Human Factors Engineering (HFE), Office of Health Informatics, Veterans Health Administration
USER Goal: Place a consult for teledermatology, and review specialist’s assessment to establish a care plan.
Scenario Description
Dr. Francis, a Primary Care Provider at the CBOC, has an appointment with a patient who has noticed a skin lesion growing. Dr. Francis, concerned that this could be a skin cancer, uses a marker to circle the lesion, enters a consult into the system for teledermatology, and directs the patient to the Telehealth Nurse who takes the images and uploads them into the system. Later that evening, the images are reviewed by a Dermatologist located at the main medical center. The next morning, Dr. Francis reviews the results of the consult and the dermatologist recommendation for a biopsy on the lesion to occur the following week. Dr. Francis reviews this information with the patient, over the phone. The dermatology clinic scheduler arranges for a biopsy and contacts the patient.
Alternatives
• If the patient’s Primary Care appointment is in a VAMC that has a dermatology clinic, the patient would go directly to Dermatology instead of having a telehealth consult.
• An LPN or RN may enter the consult information for Dr. Francis and hold it in the system for her to sign at the end of the appointment.
• If VA Dermatology is not available for the desired timeframe, a consult is entered for the VA minor procedure clinic or for non-VA care (community care).
• In lieu of Dr. Francis reviewing the results of the consult over the phone, she reviews with the patient in person.
